From the Guidelines
Lisinopril is generally preferred over enalapril for most patients due to its once-daily dosing and longer duration of action, as well as its predictability in patients with liver issues 1.
Key Differences Between Enalapril and Lisinopril
- Lisinopril has a once-daily dosing regimen, typically 10-40 mg daily, whereas enalapril requires a twice-daily regimen, usually 5-40 mg divided into two doses 1.
- Lisinopril does not require conversion in the liver to its active form, making it more predictable in patients with liver issues.
- Enalapril may be preferred in specific situations, such as for patients with severe kidney impairment, as it has dual elimination pathways.
Mechanism of Action and Side Effects
- Both medications work by blocking the angiotensin-converting enzyme, which reduces the production of angiotensin II, a powerful vasoconstrictor 1.
- This leads to blood vessel relaxation, lower blood pressure, and decreased cardiac workload.
- Side effects are similar for both and include dry cough, dizziness, headache, and rarely angioedema.
Dosing and Administration
- When switching between these medications, a rough equivalent dose is 10 mg of lisinopril to 5 mg of enalapril twice daily 1.
- Both medications should be started at lower doses and gradually increased to minimize side effects like hypotension.
Clinical Considerations
- The choice between enalapril and lisinopril should be based on individual patient factors, such as liver function, kidney function, and dosing convenience 2.
- More detailed information on the outcome of renal function is needed, above all as regards the presence of diabetic nephropathy, the amount of proteinuria, and the possible crossover to an ACE inhibitor in patients with diminished renal function 2.
From the Research
Comparison of Enalapril and Lisinopril
- Enalapril and lisinopril are both angiotensin-converting enzyme (ACE) inhibitors used to treat hypertension and congestive heart failure 3, 4.
- A study comparing the antihypertensive effects of once daily 10mg doses of lisinopril and enalapril found that lisinopril lowered mean 24 hour systolic blood pressure significantly more than enalapril after 4 weeks of treatment 4.
- Another study found that twice-daily dosing of ACE inhibitors, including lisinopril and enalapril, may promote added blood pressure-lowering effects compared to once-daily dosing 5.
Efficacy and Safety
- Lisinopril has been shown to be effective in lowering blood pressure in patients with essential hypertension, with or without the addition of hydrochlorothiazide 3, 6.
- Enalapril has been found to be effective in reducing systolic blood pressure and may be the best option when considering factors such as increased ejection fraction and decreased mean arterial pressure 7.
- However, enalapril has been associated with a higher incidence of cough, gastrointestinal discomfort, and greater deterioration in renal function compared to other ACE inhibitors 7.
Clinical Use
- The choice between enalapril and lisinopril should be based on individual patient needs and medical history, as well as consideration of factors such as dosing frequency and potential side effects 4, 5, 7.
- Both enalapril and lisinopril are generally well-tolerated, but patients should be monitored for potential side effects and adjusted as needed 3, 6.